ABSTRACT Objective: To describe the improvements of an early warning system for the identification of septic patients on the time to diagnosis, antibiotic delivery, and mortality. Methods: This was an observational cohort study that describes the successive improvements made over a period of 10 years using an early warning system to detect sepsis, including systematic active manual surveillance, electronic alerts via a telephonist, and alerts sent directly to the mobile devices of nurses. For all periods, after an alert was triggered, early treatment was instituted according to the institutional sepsis guidelines. Results: In total, 637 patients with sepsis were detected over the study period. The median triage-to-diagnosis time was reduced from 19:20 (9:10 - 38:15) hours to 12:40 (2:50 - 23:45) hours when the manual surveillance method was used (p = 0.14), to 2:10 (1:25 - 2:20) hours when the alert was sent automatically to the hospital telephone service (p = 0.014), and to 1:00 (0:30 - 1:10) hour when the alert was sent directly to the nurse's mobile phone (p = 0.016). The diagnosis-to-antibiotic time was reduced to 1:00 (0:55 - 1:30) hours when the alert was sent to the telephonist and to 0:45 (0:30 - 1:00) minutes when the alert was sent directly to the nurse's mobile phone (p = 0.02), with the maintenance of similar values over the following years. There was no difference in the time of treatment between survivors and non-survivors. Conclusion: Electronic systems help reduce the triage-to-diagnosis time and diagnosis-to-antibiotic time in patients with sepsis.

Abstract Based on the Critical Theory of Society by the philosopher Theodor Adorno, this study proposes to reflect on objective elements of the context of institutional and social structure that founded ideas regarding rationality and domination, considering subjective factors correlated to the sociologist Max Weber’s ideas. In this sense, ideas about the complex formation of the subject’s identity against the demands of human conservation, presented in the light of Sigmund Freud’s psychoanalysis, are corroborated; A discussion, although controversial, fundamental to critical theory, since it considers contributions of psychology permeated by elements that expand beyond determined, conscious or alienated behaviors. That is, it aims at cultural, historical and sociological factors as primordial bases for analysis of ideology as a rational factor which runs through the modern period.

Abstract Erdheim-Chester Disease is a rare entity, classified as an inflammatory myeloid neoplasm, with an unknown incidence, occurring preferentially in men after 50 years of age. Classically, it has a multisystemic presentation, with the skeletal system being the most frequently affected (90% of the patients), followed by genitourinary involvement in 60% of cases and central nervous system in the pituitary and diabetes insipidus in 25% of the cases. Cardiovascular manifestations are present in more than half of the patients, with aortic infiltration and atrial pseudotumor being the most common forms.

Abstract Patients with borderline personality disorder (BPD) are typically unstable and intense in their feelings and behaviors, easily arousing negative emotional reactions in their therapists. Therefore, managing countertransference is essential for psychotherapy with these patients. The present systematic case study aims to describe countertransferential manifestations in the therapeutic process of the first year of a psychoanalytical therapy with a BPD patient, broadening the empirical knowledge on how countertransference interacts with the patient’s variables. The sessions (n=59) were codified by pairs of independent judges trained with the Psychotherapy Process Q-Set (PQS), a q-sort with 100 items that give a description of the patient, the therapist and of the interaction variables that typify the treatment. Experts in psychoanalytical psychotherapy selected six PQS items as indicative of countertransferential reactions and 12, as indicators of mental states and behaviors characteristic of patients with BPD. These items were examined in relation to time. Findings reveal predominance of therapeutic attitudes compatible with positive countertransference.

Abstract This study analyses expenditure trends in Hospitalizations for Ambulatory Care Sensitive Conditions (ACSCs) in children. It is an ecological time-series study, including hospitalizations of children under five in Bahia, between 2000 and 2012. We calculate the annual ACSC rates, as well as the total and average expenditure on these hospitalizations. We construct linear regression analysis models for the temporal trends. Between 2000 and 2012, 810,831 ACSC hospitalizations for the under-fives were recorded in Bahia. Hospitalization rates dropped 24.7% over this period, falling from 44.6 to 33.6 per 1,000 children. The total expenditure on such admissions is estimated to be 155.8 million Brazilian Reals. When we compare the first with the last year of the series, we note a reduction of 50.4% in total expenditure. The linear regression analysis demonstrates a reduction trend in average ACSC expenditure (β = -1.20, p = 0.014), (β = -3.45, p <0.01) and total expenditure (β = -0,46, p <0.01). Despite the reductions in these indicators, ACSC rates remain high, which has a significant impact on the volume of resources spent on avoidable hospitalizations. To this end, it is important to reduce ACSC expenditure, to both improve population health and reduce hospital costs.

Abstract The scope of this study was to analyze the hygienic-sanitary conditions in nine School Food and Nutrition Units (UANE) of a municipality in the state of Rio de Janeiro (Brazil). A Best Practices in School Food Checklist proposed and validated by Stedefeldt et al., containing items scored and grouped into six thematic blocks (BT) was applied. The total score (P) results per BT and the final score (PF) were obtained using the Best Practices in School Food software®. The P results in UANE were compared with the classification of Collegiate Board Resolution No. 275 of 2002 of the National Health Surveillance Agency2 and PF results were used for UANE classification. All the UANE results were partially suitable for BT building. For BT handlers, processes/procedures, environmental hygiene and equipment for controlled temperature, most had partially adequate and inadequate results. Most UANE were adequate for BT reception. The PF results classified most UANE (66.7%) as standard health risks, indicating the need for corrective measures for Best Practices in UANE and the supply of safe and healthy meals to schoolchildren.

Abstract The aim of this study was to investigate the risk and protective factors for suicide attempt in emerging adulthood. 189 individuals (18 to 30 years old) participated in the study: 63 had already attempted suicide, 63 had a history of suicidal ideation, and 63 have never had suicidal ideation. They all completed an online research protocol about suicidal attempt and ideation, anxiety, self-esteem, self-efficacy, developmental stressors; social expression, and friendship. Those participants with no history of suicidal attempt showed higher scores of self-efficacy (M = 35.35, SD = 6.44), self-esteem (M = 41.33, SD = 7.02), and family relationships (M = 59.63, SD = 10.01). The suicidal ideation group showed higher scores of social anxiety (M = 26.03, SD = 10.25). Protective factors were essential to prevent the risk of suicide and help in solving problems in emerging adulthood.

Abstract The aim of this article was to evaluate the influence of biological and sociobehavioral factors on the development of malocclusions in children. This is a cross-sectional study nested in a cohort of 350 children who participated in a community intervention study. After six years, an active search identified 290 children with occlusal abnormalities. Socioeconomic status, linear growth, and nutritional status of the child at birth and at the time of measurement, as well as dietary and sucking habits, were investigated. Malocclusions were evaluated across three spatial planes - anteroposterior, vertical, and transverse. The prevalence of these anomalies was 64.5%, primarily in the anteroposterior plane. The logistic regression analysis revealed that pacifier use for 60 months or more, stunting as measured at age six, and reduced gain in head circumference from birth to six years of age, were significantly associated with the development of malocclusion in childhood. Head circumference and linear growth are associated with occlusal anomalies in infants, independent of pacifier sucking.

ABSTRACT Introduction: Muscular strength is an essential capacity for soccer players; however, the profile of this capacity has not yet been clearly established in young players. Objective: To compare muscular strength performance in the countermovement jump (CMJ) task and the presence of lower limb asymmetry among soccer athletes of the under 15 (U15), under 17 (U17) and under 20 (U20) categories, and between two teams of different competitive levels. Methods: One hundred and fifty one young soccer players of three different categories (U15, U17 and U20) from two teams in the Brazilian first and second divisions performed six vertical jumps in a system of two force plates. Ground reaction force (GRF) was used to calculate jump height and to obtain the variables Peak force (FMAX), Impulse (I) and Peak power (PMAX) with regard to body mass and the respective asymmetry values. Results: No differences were found in the performance and asymmetry variable between the categories (Jump height: p=0.23; FMAX: p=0.15; I: p=0.11; PMAX: p=0.32; FMAX asymmetry: p=0.21; I asymmetry: p=0.58; PMAX asymmetry: p=0.58). The first division club had higher muscle strength and asymmetry values than the second division club (Jump height: p<0.01; I: p<0.01; PMAX: p<0.01; FMAX asymmetry: p<0.01; I asymmetry: p<0.01; PMAX asymmetry: p<0.01), except for FMAX (p=0.63). No variable had an interaction effect (club x category). Conclusion: As categories progress, jump height, relative I, PMAX and FMAX values and their respective asymmetries are stable. The asymmetry and strength performance of the first division club were higher than that of the second division club, except for FMAX, indicating that the competitive level may influence strength performance and the development of asymmetry. Level of Evidence II; Diagnostic study – Investigating a diagnostic test.

ABSTRACT: Mastitis in dairy cattle is the disease that impacts dairy production the most; Staphylococcus aureus is the main causative agent of this condition. The genus Staphylococcus has the ability to produce biofilms, an important mechanism of antibiotic resistance. Bearing in mind that plants have therapeutic action, this study investigated the in vitro antibiofilm activity of the plant extract and compounds isolated from the species Croton urucurana, native to the Brazilian Cerrado, against Staphylococcus aureus isolated from the milk of cows with mastitis, as well as the antibiotic gentamycin and vancomicyn. The antibiofilm activity was evaluated by means of violet crystal and the counting of Colony Forming Units. The images were obtained by scanning electron microscopy. The C. urucurana crude extract and fraction displayed better antibiofilm effect than gentamycin; their antibiofilm action was similar to the action of vancomycin. Compared with all the assessed treatments, the isolated compound α-Costol was significantly more active it reduced six logarithmic cycles of the bacterial population composing the biofilm. The phytocomplexs and the α-Costol substance isolated from Croton urucurana are promising in the fight against one of the main etiological agents of bovine mastitis.

ABSTRACT The objective of this study was to characterize banana tree endophytic bacteria at genus and species level and to determine the metabolic reactions associated with the nitrogen transformations. The identification at genus and species levels was performed using the partial sequencing of the rDNA 16S region. The assimbyotic nitrogen fixation, the reduction of nitrate and the production of urease were in vitro evaluated. The DNA of the bacterial isolates was also amplified to verify the presence of the nifH, nirK and nirS regions. Biochemical tests were performed in a complete randomized design; the treatments consisted of 39 bacterial isolates with three replications. Sequence analysis enabled the identification of four genera: Bacillus, Rhizobium, Klebsiella and Enterobacter. The Bacillus genus occurred more frequently, nine species were identified. By evaluating the results of biochemical tests, it was observed that three isolates showed multiple abilities: growth in NFb medium, nitrate reduction and production of urease. The isolates belong to the genus Bacillus and of the species subtilis, thuringienses and amyloliquefaciens. Approximately 12.5% of the isolates amplified the region corresponding to the nifH gene, 7.5% amplified gene nirK and 3.9% amplified the nirS gene. Endophytic bacteria evaluated in the present study showed in vitro activity for urease, nitrate reductase enzymes, however, relevant nitrogenase activity was not observed.

Abstract This study aimed to identify the types of interventions of a psychoanalytic therapist in the psychotherapy of a patient with Borderline Personality Disorder, during a period of treatment prior to psychiatric hospitalization. The Systematic Case Study procedure was adopted with a quantitative design. For the data analysis, twelve sessions of psychotherapy were transcribed and analyzed and the interventions of the therapist were classified based on the Modified Multidimensional Classification of Psychotherapeutic Interventions (CMIP-M), which identifies types of interventions in clinical material. Pairs of independent judges trained in the methodology of the instrument evaluated and classified each of the interventions of the therapist at the descriptive level. The results were presented by means of descriptive statistics of frequency and percentage and indicated predominance of empathic (27.3%), closed exploratory (24.1%) and psychoanalytical examination (15.1%) interventions throughout the investigation process. The results showed similarities with previous studies, indicating the emphasis on closed exploratory interventions in the treatment of personality disorders. However, there were differences in relation to the previous investigations carried out with patients diagnosed with Borderline Personality Disorder, in which expressive interventions predominated.